490 AFFECTIONS OF THE (ESOPHAGUS. 



by abscesses on the anterior surface of the spine, by caries of the 

 vertebrae, even by tuberculous cavities in the lungs, etc. 



Rupture of the oesophagus without precedent disease has only 

 been observed in a very few cases (Boerhaave, Oppolzer). It more 

 frequently happens that the wall of the oesophagus, which has been 

 almost destroyed by carcinoma, corrosion, or ulcers, and nearly per- 

 forated, is suddenly ruptured by severe retching and vomiting. 



If the wall of the oesophagus is opened in any way, its contents 

 pass into the surrounding connective tissue, or communication is 

 opened with the trachea, pleural or pericardial sacs, or with the 

 great vessels. 



Before perforation or rupture of the oesophagus occurs, the 

 advancing destruction may cause adhesive inflammation of the 

 adjacent organs, the symptoms of which precede the perforation. 

 I have seen double pleurisy and pericarditis gradually develop in a 

 man with carcinoma of the (esophagus ; on post-mortem examination 

 I found the parts of the pleura and pericardium lying next the can- 

 cer discolored and mortified, but no escape of the contents of the 

 oesophagus into those cavities. Sudden, severe pain, deep in the 

 breast, usually indicates the moment of perforation ; besides this 

 there are chill, paleness and coolness of the extremities, fainting, 

 and sometimes, depending on the seat of the perforation, attacks of 

 suffocation, or symptoms of severe pleurisy, or profuse vomiting of 

 blood. Death sometimes occurs immediately. There can be no 

 treatment, [except that in cases where there is any hope of recov- 

 ery we should allow no food by the mouth, and should nourish by 

 the rectum.] 



CHAPTER VI. 



NERVOUS AFFECTIONS OF THE OESOPHAGUS. 



GLOBUS hystericus, or the feeling of a ball rising to a certain 

 point in the oesophagus and remaining there, has been called hyper- 

 wsthesia (i. e., increased excitability of the sensory nerves) of the 

 oesophagus. We have already mentioned globus hystericus when 

 speaking of the nervous affections of the larynx. Some cases that 

 are described as spasm of the oesophagus should also be reckoned 

 among the hyperaesthesiae ; such as those where the patient feels as 

 if the oesophagus were ligated, and thinks he cannot swallow. This 

 state not unfrequently occurs in persons that have been bitten by 

 dogs. Andral relates a case where Boyer was obliged to stay with 

 a patient at meal-times for a whole month, because she thought she 

 would suffocate as soon as she attempted to swallow. 



